106
Received by:
Chris Masterson 0
Christine Fulton ~
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
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FOIL Ser. #:
DEPARTMENT:
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ACCOUNTmG 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE mSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGmEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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Date Applicant Contacted:
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Date FOIL fulfilled or denied:
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Closed by:
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Notes:
Amount Due8 Pages for a total of $ 5CJ
Name: A '6
Address: 3 7 /...P~~- lis).
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Agency or firm: -. .5 tELF -
Telephone #: ( t~ ~- {bl.s-F AX #: (
Email address:
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o check here if you are
requesting that the records
be mailed to this address.
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SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
o I request to be notified when I can come to inspect the record( s) described above
o I request copies of the records described above and agree to pay the cost of such records in
accordance with the fee schedule on the back of this application
o I request that the records be sent via e-mail to the address listed above
o I request that the records be faxed to the number listed above
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